Mark Arnold

Distribution and Quantitative Estimates of Variant Creutzfeldt-Jakob Disease Prions in Tissues of Clinical and Asymptomatic Patients

In the United-Kingdom, ≈1 of 2,000 persons could be infected with variant Creutzfeldt-Jakob disease (vCJD). Therefore, risk of transmission of vCJD by medical procedures remains a major concern for public health authorities. In this study, we used in vitro amplification of prions by protein misfolding cyclic amplification (PMCA) to estimate distribution and level of the vCJD agent in 21 tissues from 4 patients who died of clinical vCJD and from 1 asymptomatic person with vCJD. PMCA identified major levels of vCJD prions in a range of tissues, including liver, salivary gland, kidney, lung, and bone marrow. Bioassays confirmed that the quantitative estimate of levels of vCJD prion accumulation provided by PMCA are indicative of vCJD infectivity levels in tissues. Findings provide critical data for the design of measures to minimize risk for iatrogenic transmission of vCJD.

Development of risk-based trading farm scoring system to assist with the control of bovine tuberculosis in cattle in England and Wales.

Identifying and ranking cattle herds with a higher risk of being or becoming infected on known risk factors can help target farm biosecurity, surveillance schemes and reduce spread through animal trading. This paper describes a quantitative approach to develop risk scores, based on the probability of infection in a herd with bovine tuberculosis (bTB), to be used in a risk-based trading (RBT) scheme in England and Wales. To produce a practical scoring system the risk factors included need to be simple and quick to understand, sufficiently informative and derived from centralised national databases to enable verification and assess compliance. A logistic regression identified herd history of bTB, local bTB prevalence, herd size and movements of animals onto farms in batches from high risk areas as being significantly associated with the probability of bTB infection on farm. Risk factors were assigned points using the estimated odds ratios to weight them. The farm risk score was defined as the sum of these individual points yielding a range from 1 to 5 and was calculated for each cattle farm that was trading animals in England and Wales at the start of a year. Within 12 months, of those farms tested, 30.3% of score 5 farms had a breakdown (sensitivity). Of farms scoring 1-4 only 5.4% incurred a breakdown (1-specificity). The use of this risk scoring system within RBT has the potential to reduce infected cattle movements; however, there are cost implications in ensuring that the information underpinning any system is accurate and up to date.

Assessing the sensitivity of European surveillance for detecting BSE in cattle according to international standards

European surveillance for Bovine Spongiform Encephalopathy (BSE), initiated in 2001, has shown a steady exponential decline in the number of infected cattle, demonstrating that control measures have been effective. In 2016 23 European countries out of 28 demonstrated negligible risk status for the disease. The international standard setting body, the World Organization for Animal Health (OIE), prescribes that for countries where there is a non-negligible BSE risk, surveillance should allow the detection of one case per 100,000 in the adult cattle population with 95% confidence (Type A surveillance). The Cattle TSE Monitoring Model (C-TSEMM) was developed to estimate the sensitivity of surveillance systems to detect BSE in cattle. The model includes a cohort-based back calculation model to estimate the number and age of infected animals, the subset of those that are detectable by the diagnostic test, and the stream by which infected animals exit the standing population, that is, healthy slaughter, emergency slaughter, fallen stock and clinical suspects. Data collected by the European Commission (EC) and European Food Safety Authority (EFSA), containing the details of over 91 million cattle tested within the European Member States (EU25) surveillance scheme from 2002 to 2011, was used to populate the model. When considering the EU25 surveillance scheme as a single epidemiological unit, the model estimated that the surveillance scheme in place exceeded the OIE required threshold for Type A surveillance, and that a revised monitoring system excluding all healthy slaughter animals would also exceed this threshold. Results indicated a variation in individual country sensitivity of surveillance with seven countries (Germany, Spain, France, Ireland, Italy, Poland and the UK) exceeding the required threshold individually. Key assumptions included the fitting of an exponential distribution for all countries to describe the decline in prevalence over time and, for those members with no detected cases of BSE, an estimated area prevalence was used as a proxy. These results were part of the evidence base that lifted the testing requirement for healthy slaughter animals in European countries in 2013. The model has been maintained and updated by EFSA each year with the addition of new member states, and updated surveillance data.

Mononucleated Blood Cell Populations Display Different Abilities To Transmit Prion Disease by the Transfusion Route

ABSTRACT Previous experiments carried out in a sheep scrapie model demonstrated that the transfusion of 200 μl of prion-infected whole blood has an apparent 100% efficacy for disease transmission. These experiments also indicated that, despite the apparent low infectious titer, the intravenous administration of white blood cells (WBC) resulted in efficient disease transmission. In the study presented here, using the same transmissible spongiform encephalopathy (TSE) animal model, our aim was to determine the minimal number of white blood cells and the specific abilities of mononucleated cell populations to transmit scrapie by the transfusion route. Our results confirmed that the transfusion of 100 μl, but not 10 μl, of fresh whole blood collected in asymptomatic scrapie-infected donor sheep can transmit the disease. The data also show that the intravenous administration of 105 WBCs is sufficient to cause scrapie in recipient sheep. Cell-sorted CD45R+ (predominantly B lymphocytes), CD4+/CD8+ (T lymphocytes), and CD14+ (monocytes/macrophages) blood cell subpopulations all were shown to contain prion infectivity by bioassays in ovine PrP transgenic mice. However, while the intravenous administration of 106 CD45+ or CD4+/8+ living cells was able to transmit the disease, similar numbers of CD14+ cells failed to infect the recipients. These data support the contention that mononucleated blood cell populations display different abilities to transmit TSE by the transfusion route. They also represent an important input for the risk assessment of blood-borne prion disease transmission and for refining the target performance of leukoreduction processes that currently are applied to mitigate the transmission risk in transfusion medicine. IMPORTANCE Interindividual variant Creutzfeldt-Jakob disease (vCJD) transmission through blood and blood-derived products is considered a major public health issue in transfusion medicine. Over the last decade, TSE in sheep has emerged as a relevant model for assessing the blood-borne vCJD transmission risk. In this study, using a sheep TSE model, we characterized the ability of different peripheral blood mononucleated cell populations to infect TSE-free recipients by the transfusion route. Our results indicate that as little as 105 WBC and 100 μl of blood collected from asymptomatic scrapie infected animals can transmit the disease. They also demonstrate unambiguously that peripheral blood mononuclear cell subpopulations display dramatically different abilities to transmit the disease. These data represent an important input for the risk assessment of blood-borne prion disease transmission and for refining the target performance of leukoreduction processes that currently are applied to mitigate the transmission risk in transfusion medicine.

Is there a decline in bovine spongiform encephalopathy cases born after reinforced feed bans? A modelling study in EU member states

Occasional cases of classical bovine spongiform encephalopathy (BSE) still continue to occur within the European Union (EU) for animals born after reinforced feed bans (BARBs), which should in theory have eliminated all risk of infection. The study aimed to determine (i) whether a common rate of decline of BSE infection was evident across EU member states, i.e. to determine whether control measures have been equally effective in all member states, (ii) whether there was any evidence of spontaneous occurrence of BSE in the data and (iii) the expected date for the last BSE case in UK. It was found that there was no significant difference in the rate of decline of BSE prevalence between member states, with a common rate of decline of 33·9% per annum (95% CI 30·9-37%) in successive annual birth cohorts. Trend analysis indicated an ultimate decline to 0 prevalence, suggesting that spontaneous occurrence does not explain the majority of cases. Projecting forward the trends from the back-calculation model indicated that there was approximately a 50% probability of further cases in the UK, and should the current rate of decline continue, there remains the possibility of further occasional cases up until 2026.

Estimation of the sensitivity of various environmental sampling methods for detection of Salmonella in duck flocks

Reports of Salmonella in ducks in the UK currently rely upon voluntary submissions from the industry, and as there is no harmonized statutory monitoring and control programme, it is difficult to compare data from different years in order to evaluate any trends in Salmonella prevalence in relation to sampling methodology. Therefore, the aim of this project was to assess the sensitivity of a selection of environmental sampling methods, including the sampling of faeces, dust and water troughs or bowls for the detection of Salmonella in duck flocks, and a range of sampling methods were applied to 67 duck flocks. Bayesian methods in the absence of a gold standard were used to provide estimates of the sensitivity of each of the sampling methods relative to the within-flock prevalence. There was a large influence of the within-flock prevalence on the sensitivity of all sample types, with sensitivity reducing as the within-flock prevalence reduced. Boot swabs (individual and pool of four), swabs of faecally contaminated areas and whole house hand-held fabric swabs showed the overall highest sensitivity for low-prevalence flocks and are recommended for use to detect Salmonella in duck flocks. The sample type with the highest proportion positive was a pool of four hair nets used as boot swabs, but this was not the most sensitive sample for low-prevalence flocks. All the environmental sampling types (faeces swabs, litter pinches, drag swabs, water trough samples and dust) had higher sensitivity than individual faeces sampling. None of the methods consistently identified all the positive flocks, and at least 10 samples would be required for even the most sensitive method (pool of four boot swabs) to detect a 5% prevalence. The sampling of dust had a low sensitivity and is not recommended for ducks.

Estimating the impact on food and edible materials of changing scrapie control measures: the Scrapie Control Model

Multiple controls established during the bovine spongiform encephalopathy (BSE) epidemic were not solely applied to BSE in cattle, but were implemented for scrapie in sheep and goats due to concerns over the occurrence of BSE in sheep. In the absence of BSE in sheep being observed, control measures for prion diseases are now being evaluated to ensure they remain proportionate to risk. This risk assessment, aims to estimate, by use of stochastic simulation, the impact of reducing controls for Specified Risk Materials (SRM) from sheep at abattoir. Three scenarios have been included: 1) current list of SRM; 2) brain and spinal cord of adult sheep; and 3) the brain of adult sheep. Results indicate the total amount of infectivity passing through British abattoirs is highest for atypical scrapie with nearly 3,500,000 Ovine Oral (OO) ID50 per year. The majority of this infectivity enters Category 1 waste for incineration, with only 13,000 OO ID50 per year within edible products. Under Scenario 2, an additional 4000 OO ID50 per year would be classified as edible products from the lifting of restrictions on the distal ileum of adult sheep. However, if SRM removal was limited to brain, an additional 110,000 OO ID50 per year would be permitted into edible products with the lifting of restrictions on the spinal cord of adult sheep. For classical scrapie, there is a mean estimate of infectivity of 30,000 OO ID50 per year at abattoir. This is lower than for atypical scrapie due to the lower occurrence of this disease in Great Britain. However, more infectivity is destined to reach the food chain as the disease is peripherally distributed in the carcase. The highest contributor to the total amount of infectivity consumed per year is the intestines (duodenum and jejunum). If SRM removal is limited to the brain and spinal cord of sheep over 12 months of age, there is an approximate mean increase from 19,000 to 21,000 OO ID50 per year diverted to edible products. If the SRM list is restricted to brain only, this increases to over 23,000 OO ID50 per year. For the potential of sheep-BSE, there is a very low estimate of 29 OO ID50 per year in total from carcases entering abattoir, due to the potential very rare occurrence of this disease. Given changes in SRM regulations there is a change of an additional 4 OO ID50 per year being diverted to edible products.

Spatio-temporal and risk factor analysis of alleles related to Scrapie resistance in sheep in Great Britain before, during and after a national breeding program

Certain genotypes of sheep have been identified to increase their susceptibility (the VRQ allele) or resistance (the ARR allele) to classical scrapie. This studys aim was to assess the spatio-temporal pattern of the ARR and VRQ alleles in Great Britain (GB) and to explore the risk factors associated to their presence. Data was collected from the GB scrapie active surveillance program, the sheep and goat inventory survey (GB census survey) and the agricultural survey for the period 2002-2015. Spatio-temporal trends of genotypes were assessed through the use of choropleth maps, spatial cluster and linear regression analyses. Multivariable mixed effect logistic regression analyses were performed to investigate the association between the resistant or susceptible genotypes, and breeds, farm purpose, animal purpose, surveillance stream, country location and herd size. The results show a significant upward trend in the frequency of most resistant ARR alleles (1.15% per year, 95%CI: 0.76-1.53) and significant downward trend of most susceptible VRQ alleles (-0.40% per year; 95%CI: -0.69 to -0.10]. The trend continues after the termination of the national scrapie plan in 2009. Breeds such as Herdwick (OR = 0,26; 95%CI: 0.14-0.46), Shetland (OR = 0.22; 95%CI: 0.13-0.39), Swaledale (OR = 0.58; 95%CI: 0.47-0.73), Scottish blackface (OR = 0.54; 95%CI: 0.41-0.71) and Welsh Montain (OR: 0.59; 95%CI: 0.44-0.79) were identified with lower odds ratios of having the resistant ARR allele, while Beulah speckled face (OR = 1.58; 95%CI: 1.04-2.41), Jacob (OR = 2.91; 95%CI: 1.33-6.40), Lleyn (OR = 2.94; 95%CI: 1.28-6.74) and Suffolk (OR = 2.19; 95%CI: 1.69-2.84) had higher odds ratios of having the ARR allele. Other risk factors associated to presence of ARR allele were finishing farms (OR = 1.15; 95%CI: 1.06-1.24) and farms in Scotland (OR = 0,78; 95%CI: 0.73-0.83) and in Lowland grazing areas (OR = 1.53; 95%CI: 1.39-1.67). Factors associated with presence the VRQ genotype were farms in Scotland (OR = 0,85; 95%CI: 0.77-0.93) and breeds such as Herdwick (OR = 2.2; 95%CI: 1.08-4.97), Shetland (OR = 4.12; 95%CI: 2.20-7.73) and Sweledale (OR = 1.51; 95%CI: 1.10-2.09). For the most resistant genotype, two significant spatial clusters were identified: a high-risk cluster in the south-west of GB (RR = 1.51, p < 0.001) and a low-risk cluster in northern GB (RR = 0.65, p < 0.001). For the most susceptible genotypes, one significant high-risk cluster was identified in Wales (RR = 2.89 and p = 0.013). Surveillance for classical scrapie could be improved with a risk-based approach by focussing on those areas and farm types identified to have higher frequency of VRQ alleles and less frequency of ARR alleles. Scrapie control strategies could focus on developing breeding programs on farms with Shetland, Herdwick and Swaledale breeds.

Infectivity in bone marrow from sporadic CJD patients

Prion infectivity was recently identified in the blood of both sporadic and variant Creutzfeldt–Jakob disease (CJD) patients. In variant CJD (vCJD), the widespread distribution of prions in peripheral tissues of both asymptomatic and symptomatic patients is likely to explain the occurrence of the observed prionaemia. However, in sporadic CJD (sCJD), prion infectivity is described to be located principally in the central nervous system. In this study, we investigated the presence of prion infectivity in bone marrow collected after death in patients affected with different sCJD agents. Bioassays in transgenic mice expressing the human prion protein revealed the presence of unexpectedly high levels of infectivity in the bone marrow from seven out of eight sCJD cases. These findings may explain the presence of blood‐borne infectivity in sCJD patients. They also suggest that the distribution of prion infectivity in peripheral tissues in sCJD patients could be wider than currently believed, with potential implications for the iatrogenic transmission risk of this disease. Copyright

Evidence for more cost-effective surveillance options for bovine spongiform encephalopathy (BSE) and scrapie in Great Britain

Transmissible spongiform encephalopathies (TSEs) are an important public health concern. Since the emergence of bovine spongiform encephalopathy (BSE) during the 1980s and its link with human Creutzfeldt–Jakob disease, active surveillance has been a key element of the European Union’s TSE control strategy. Success of this strategy means that now, very few cases are detected compared with the number of animals tested. Refining surveillance strategies would enable resources to be redirected towards other public health priorities. Cost-effectiveness analysis was performed on several alternative strategies involving reducing the number of animals tested for BSE and scrapie in Great Britain and, for scrapie, varying the ratio of sheep sampled in the abattoir to fallen stock (which died on the farm). The most cost-effective strategy modelled for BSE involved reducing the proportion of fallen stock tested from 100% to 75%, producing a cost saving of ca GBP 700,000 per annum. If 50% of fallen stock were tested, a saving of ca GBP 1.4 million per annum could be achieved. However, these reductions are predicted to increase the period before surveillance can detect an outbreak. For scrapie, reducing the proportion of abattoir samples was the most cost-effective strategy modelled, with limited impact on surveillance effectiveness.